To describe the classic findings of chronic pancreatitis with different imaging techniques,
explaining its advantages and limitations.
To propose a diagnostic algorithm: from non-invasive techniques to invasive procedures.
Chronic pancreatitis (CP) is a progressive fibroinflammatory process of the pancreas that results in permanent structural damage,
which leads to impairment of exocrine and endocrine function.
The clinical manifestations ofCP may include abdominal pain,
steatorrhea and diabetes,
as well as numerous acute and chronic complications.
a subset ofCP patients develop pancreatic adenocarcinoma,
which is generally advanced at the time of diagnosis due to the marked morphologic changes in the gland that may “mask” tumors,
diagnostic tools allowing early diagnosis are mandatory.
Findings and procedure details
The diagnosis of CP is based on symptoms,
morphological changes on imaging tests and / or functional tests which demonstrate exocrine pancreatic insufficiency.
Morphological changes are detected with greater sensitivity by echoendoscopy.
the invasive nature of this procedure and its limitations to evaluate complications related to the disease,
explain the need of alternative diagnostic tools.
In this scenario,
both CT and MRI as well as transabdominal ultrasound play an important role.
Imaging for Chronic Pancreatitis
Transabdominal Ultrasoundhas been used for many years to evaluate...
Diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes in CP.
The workup of suspected CP should follow a progressively noninvasive to more invasive STEP-wise approach in a patient with a suspicious clinical presentation and risk factors (Table 1).
CTremains the best initial imaging modality to obtain as it has good sensitivity for severe CP and may obviate the need for other diagnostic tests.
an MRCP should...
Mortele K et al.
American Pancreatic Association Practice Guidelines in Chronic Pancreatitis.
Ní Chonchubhair HM,
Chronic pancreatitis: A diagnostic dilemma.
World J Gastroenterol 2016;22(7):2304-2313
Chronic Pancreatitis: Ultrasound,
and Magnetic Resonance Imaging Features.
Seminars in Ultrasound,
CT and MRI.
Grenacher L et al.